In-vitro validation, with histology, of intravascular ultrasound in renal arteries

Leertouwer, Trude C.; Gussenhoven, Elma J.; Jaarsveld, Brigit C. van; Overhagen, Hans van; Bom, N.; Veld, A. J. Man In 'T

doi:10.1097/00004872-199917020-00012

Cited by 12 publications

(9 citation statements)

References 20 publications

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“…In human renal arteries, previous comparisons between the IVUS image and histopathological features have been reported (9,28); however, plaque components were not fully described. Our findings showed that necrotic core and dense calcium had significant correlations with positive remodeling in both RAS and CAD lesions.…”

Section: Discussionmentioning

confidence: 99%

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Association of Plaque Composition and Vessel Remodeling in Atherosclerotic Renal Artery Stenosis

Kataoka

Rubinshtein

Rihal

et al. 2009

JACC: Cardiovascular Imaging

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OBJECTIVES The current study was designed to investigate the relationship between renal arterial structure and vessel remodeling in patients with atherosclerotic renal artery stenosis (RAS), compared with that seen in coronary artery disease (CAD). BACKGROUND The nature and the tissue characterization of atherosclerotic RAS lesions have not been fully explored. METHODS Gray scale and virtual histology (VH) intravascular ultrasound imaging was used to assess 23 lesions in 14 consecutive RAS patients and 20 left main trunk lesions in age-matched CAD patients. Analysis included assessment of vessel area and atherosclerotic plaque area of the main renal artery or left main trunk. Plaque was characterized as fibrous tissue, fibro-fatty tissue, necrotic core, and dense calcium. Remodeling was assessed by means of the remodeling index (RI). RESULTS Positive remodeling (defined as RI ≥1.05) was present in 15 RAS and 9 CAD lesions, whereas intermediate/negative remodeling (RI <1.05) was present in 8 RAS and 11 CAD lesions. VH showed that the fibrous tissue was the most prominent plaque composition, followed by fibro-fatty, necrotic core, and dense calcium in both vascular beds. Greater vascular adaptive enlargement was observed in slices with plaque burden ≤40% compared with plaque burden >40% (p < 0.001 for all). Vessel area had a positive association with the area of all VH components (p < 0.001, for all). VH analysis shows that the most powerful determinant of adaptive vessel enlargement is dense calcium in RAS (p < 0.001), while that is necrotic core in CAD (p < 0.001). Necrotic core and dense calcium areas were greater in lesions with positive remodeling compared with intermediate/negative remodeling (p = 0.03, p = 0.03, respectively, in RAS; p = 0.005, p = 0.03, respectively, in CAD). CONCLUSIONS The current study demonstrates in humans that plaque composition as assessed by VH intravascular ultrasound has an important role of adaptive vessel enlargement, and it is related to renal artery remodeling in RAS in a pattern similar to CAD.

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Section: Discussionmentioning

confidence: 99%

“…Such adaptive enlargement of vessels can compensate for the accumulation of atherosclerotic plaque in vivo to preserve the vessel lumen (8). The remodeling process has not been elucidated in atherosclerotic RAS, and intravascular ultrasound imaging (IVUS) may be feasible and useful for the assessment of atherosclerotic RAS (9–11). …”

mentioning

confidence: 99%

Association of Plaque Composition and Vessel Remodeling in Atherosclerotic Renal Artery Stenosis

Kataoka

Rubinshtein

Rihal

et al. 2009

JACC: Cardiovascular Imaging

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“…The latter phenomenon was responsible for symptomatic RAS in 50% of patients, a prevalence of coarctation similar to that previously seen in our autopsy study. 3 Coarctation could be identified even after balloon dilatation in 44% of the patients. The present study is the first in which coarctation as a cause of RAS was evidenced clinically.…”

Section: Discussionmentioning

confidence: 93%

“…1,2 A recent intravascular ultrasound (IVUS) study in human renal arteries obtained at autopsy, however, suggested an alternative cause of RAS. 3 In that study, we observed that in 60% of the specimens, plaque accumulation, with or without compensatory vessel enlargement (ie, adaptive remodeling), caused lumen narrowing. This phenomenon was first described by Glagov et al 4 and, subsequently, by others.…”

mentioning

confidence: 89%

“…A relative MBA of Ͼ85% at the target site indicated a similar or larger MBA ("adaptive remodeling" group), and a relative MBA of Յ85% at the target site indicated a smaller MBA than at the reference site ("coarctation" group). On the basis of our previous observation that renal artery tapering does not occur, 3 we used a 15%-tolerance interval to define a smaller MBA to be on the conservative side. We assessed whether the conclusions of the quantitative analysis, which were performed by 2 independent observers (T.C.L.…”

Section: Image Analysismentioning

confidence: 99%

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Intravascular Ultrasound Evidence for Coarctation Causing Symptomatic Renal Artery Stenosis

et al. 1999

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Background-A recent study of human cadaveric renal arteries revealed that renal artery narrowing could be due not only to atherosclerotic plaque compensated for by adaptive remodeling, but also to hitherto undescribed focal narrowing of an otherwise normal renal arterial wall (ie, coarctation). The present study investigated whether vessel coarctation could be identified in patients with symptomatic renal artery stenosis (RAS). Methods and Results-Consecutive symptomatic patients with angiographically proven atherosclerotic RAS who were referred for stent placement were studied by 30-MHz intravascular ultrasound before intervention (nϭ18) or after predilatation (nϭ18). Analysis included assessment of the media-bounded area and plaque area (PLA) at the most stenotic site and at a distal reference site (most distal cross-section in the main renal artery with normal appearance).Coarctation was considered present whenever the target/reference media-bounded area was Յ85%. Before intervention, coarctation was observed in 9 of 18 patients and adaptive remodeling in 9 of 18 patients. Coarctation lesions had a significantly smaller PLA than adaptive remodeled lesions (Pϭ0.001). Similarly, despite predilatation, coarctation was seen in 8 of 18 patients who had significantly smaller PLAs (Pϭ0.008) when compared with those patients who had adaptive remodeled lesions. No differences in severity of RAS or angiographic or clinical parameters were observed. Conclusions-Low-plaque coarctation may cause a considerable proportion of symptomatic RAS, which is angiographically and clinically indistinguishable from plaque-rich RAS. (Circulation. 1999;99:2976-2978.)

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Peripheral Intravascular Ultrasonography

Gussenhoven¹,

Hagenaars²,

Essen³

et al. 2002

Pan Vascular Medicine

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In-vitro validation, with histology, of intravascular ultrasound in renal arteries

Abstract: Intravascular ultrasound is a reliable technique for distinguishing renal arteries with or without a lesion. Both plaque development and local vessel narrowing may result in renal artery stenosis.

Cited by 12 publications

References 20 publications

Association of Plaque Composition and Vessel Remodeling in Atherosclerotic Renal Artery Stenosis

Association of Plaque Composition and Vessel Remodeling in Atherosclerotic Renal Artery Stenosis

Intravascular Ultrasound Evidence for Coarctation Causing Symptomatic Renal Artery Stenosis

Peripheral Intravascular Ultrasonography

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